Abdominal incisional endometrioma following cesarean section: a case report.

A 34 year old woman underwent a cesarean section for placenta previa when she was 25 years old, after that she took oral contraceptives regularly for 8 years and remained asymptomatic. Upon entering our hospital, the patient stopped taking the oral contraceptives and had a one year history of cyclic bleeding from the lower midline abdominal incision scar. Surgical excision was done and pathological findings revealed endometrioma.

Management of celiac artery aneurysm: a case report.

A case of CAA in a 68-year-old male patient is reported. The patient had vague abdominal pain for 1 year. Physical examination revealed a pulsatile abdominal mass on the epigastrium. Abdominal ultrasonography and visceral arteriography confirmed the diagnosis of CAA. Aneurysmectomy with direct implantation was performed transabdominally.

The retroperitoneal approach for abdominal aortic aneurysms.

Graft replacement has become the reliable and effective form of treatment for abdominal aortic aneurysms (AAA). Operative therapy remains the major undertaking with significant rates of postoperative morbidity and mortality. The use of retroperitoneal approach has been proposed as an alternative to standard midline transabdominal approach. Over a 5 year period, 43 consecutive nonrandomized infrarenal AAA patients underwent elective surgical correction by the authors. 32 patients with the mean age of 75 underwent transabdominal reconstructive procedures for AAA. The average size of AAA was 5.9 cm and operative time was 3 hours and 25 minutes. The mortality rate was 6.25 per cent (2 of 32). The cause of death was myocardial infarction 1, and acute renal failure 1. There are many complications in the transabdominal group. 11 had prolonged ileus, 2 MI, 2 wound dehiscence, 2 atelectasis, 1 acute renal failure and 1 chylous ascites. In 11 patients with retroperitoneal approach, the average size of AAA was 5.6 cm and operative time was 3 hours and 29 minutes. No operative mortality, the only 1 complication was retroperitoneal hematoma. The most notable difference between the retroperitoneal group and transabdominal group was the speed and ease of postoperative recovery. The patients in the retroperitoneal group needed a shorter period of intubation, nasogastric drainage, stay in the intensive care unit and hospital. Patients in the retroperitoneal group also resumed oral alimentation sooner, shorter and smoother postoperative course. The patients in the retroperitoneal group had less blood loss and fewer transfusions than in the transabdominal group. Findings from our experience using the left retroperitoneal approach for a reconstructive procedure of AAA indicate that it results in fewer overall physiologic disturbances of the patients. We believe that the left retroperitoneal approach is a useful surgical access of choice for the elective repair of AAA.

Esophageal conduit in nearly hopeless corrosive esophageal stricture patient.

The case report of a 28 year old woman with strictured esophagus from corrosive esophagitis for 4 months is presented. Barium swallowing showed a strictured esophagus extending from T2 to the aortic knob and needed frequent dilatations. The patient had a perforated thoracic esophagus and mediastinitis on last dilatation. Cervical esophagostomy, transabdominal esophageal bandaging and jejunostomy feeding were done along with intravenous broad spectrum antibiotics. On esophagoscopy, there was complete stenosis of the cervical esophagus 2 cm from the postcricoid area. The large intestine from the caecum, transverse colon and descending colon was chosen as the esophageal conduit because of adequate length to pass subcutaneously. The caecum was anastomosed to the cervical esophagus and descending colon to the stomach. Seven days postoperatively, the patient could take liquids and soft porridge orally. There was a small leakage from the cervical anastomosed, spontaneous closure was achieved 3 weeks postoperatively. We chose the right side colon as the esophageal conduit because of adequate length to pass subcutaneously. Mediastinal and transhiatal routes could not be passed because of previous mediastinitis from thoracic esophageal perforation. This may be an alternative choice of operation for high cervical esophageal stenosis with previous mediastinitis.

A simple tunneler for extra-anatomical bypass grafts and interposition arteriovenous hemodialysis fistulas.

A simple and inexpensive tunneler has been employed in arterial grafting encompassing femoropopliteal, aortofemoral, axillo femoral bypass and vascular access procedures. This is fashioned from a disposable Argyle thoracostomy tube. This technique is recommended because of its simplicity, ready availability, lack of expense, and relative safety.